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NPI Code Detail

MEDICARE: STEFANO FANFONI LMFT, PHD CANDIDATE

MEDICARE: STEFANO FANFONI LMFT, PHD CANDIDATE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMT3697FL

General Provider Information

NPI Number : 1568188639
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFANO FANFONI LMFT, PHD CANDIDATE
Provider Business Mailing Address
First Line : 1263 E LAS OLAS BLVD STE 202B
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33301-2376
Country : US
Telephone Number : 973-873-4445
Fax Number :
Provider Business Practice Location Address
First Line : 1263 E LAS OLAS BLVD STE 202B
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33301-2376
Country : US
Telephone Number : 973-873-4445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2022
Last Update Date : 10/19/2022

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